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Chloroquine remains the first-line therapy for uncomplicated malaria in Indonesia. Among a series of trials of chloroquine for malaria on this archipelago conducted since 1990, we now report the highest risk of therapeutic failure yet observed. A clinical trial of standard chloroquine therapy for uncomplicated malaria at Arso PIR V in northeastern Indonesian Papua was conducted during 1995. We enrolled 104 non-immune subjects infected with Plasmodium falciparum (n = 55), P. vivax (n = 29), or P. falciparum plus P. vivax (n = 20) and administered supervised standard chloroquine therapy (10 + 10 + 5 mg/kg at 24-hour intervals). The 28-day cumulative incidence of therapeutic failure was 95% for P. falciparum, 84% for P. vivax, and 100% for mixed infections. Only one subject each for P. falciparum and P. vivax remained free of parasites at day 28. All recurrent parasitemias occurred with whole blood levels of chloroquine plus desethylchloroquine exceeding 100 ng/ml. These findings document almost complete failure of chloroquine against P. falciparum or P. vivax near the northeastern coast of Indonesian Papua.
Received August 14, 2002. Accepted for publication December 23, 2002.
Acknowledgments: We thank the officials of the Ministry of Health, Government of Indonesia, especially Dr. Sumaryati Aryoso in Jakarta; Dr. Slamet Harjosuwarno and Dr. Lana of the Provincial Health Service in Jayapura, Papua; Patriot, Mantri Hendrik, and Sukimin; Sofyan Sauri (the Department of Transmigration officer in charge of Arso Pir V) and his assistant, Supriyanto, for their advice and assistance.
Financial support: This work was supported by the U.S. Department of Defense Global Emerging Infections Surveillance Program.
Disclaimer: The views of the authors expressed herein are their own and do not purport to reflect those of the U.S. Navy or the Department of Defense.
Authors’ addresses: Iwa W. Sumawinata, Budhi Leksana, Awalludin Sutamihardja, Purnomo, and J. Kevin Baird, U.S. Naval Medical Research Unit No. 2, American Embassy, Jakarta, Indonesia, FPO AP 96520-8132, Fax: 62-21-424-4507, E-mail: bairdjk{at}namru2.med.navy.mil. Bernadeta and Budi Subianto, Provincial Health Service, Abepura, Papua, Indonesia. Sekartuti, Infectious Disease Research Center, Ministry of Health, Jakarta, Indonesia. David J. Fryauff, Malaria Program, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910-7500.
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